scholarly journals Cyclic Vomiting Syndrome in Pediatric Patients: A Review of Therapeutics

2021 ◽  
Vol 27 (1) ◽  
pp. 12-18
Author(s):  
Emma M. Tillman ◽  
Emily M. Harvath
Keyword(s):  
Complex Disease ◽  
Standard Of Care ◽  
Gastrointestinal Disorder ◽  
Therapeutic Interventions ◽  
Cyclic Vomiting Syndrome ◽  
Medical Databases ◽  
Extensive Search ◽  
American Society ◽  
Cyclic Vomiting ◽  
Sedative Agents

Cyclic vomiting syndrome (CVS) is a functional gastrointestinal disorder that can present quite a challenge to clinicians caring for children with this complex disease. Different therapeutic interventions are recommended for prophylaxis and acute abortive therapy for a CVS attack. The aim of this review is to summarize therapeutic treatment recommendations from the 2008 North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHN) Consensus Statement on the Diagnosis and Management of Cyclic Vomiting Syndrome and discuss studies contemporary to this expert recommendation. After an extensive search of medical databases, 8 studies that evaluated therapeutic treatments for CVS were identified. Amitriptyline and cyproheptadine remain the standard of care for prophylaxis. Nutritional supplements such as carnitine and coenzyme Q10 have shown efficacy in decreasing episodes and severity in small studies with high tolerability among patients. The combination of ondansetron and sumatriptan are recommended for abortion of an acute vomiting episode, but other agents such as aprepitant and sedative agents can be considered when vomiting is refractory to initial treatments.

Efficacy of Coenzyme Q10 in the Treatment of Cyclic Vomiting Syndrome in Children

2021 ◽  
Vol 6 (1) ◽  
Author(s):  
Brezin F ◽  
◽  
Wiedemann A ◽  
Bansept C ◽  
Albuisson E ◽  
...  
Keyword(s):  
Coenzyme Q10 ◽  
Gastrointestinal Disorder ◽  
Cyclic Vomiting Syndrome ◽  
Line Treatment ◽  
First Line ◽  
Excellent Safety Profile ◽  
Third Line ◽  
One Year ◽  
First Line Treatment ◽  
Cyclic Vomiting

Cyclic Vomiting Syndrome (CVS) is a chronic functional gastrointestinal disorder related to migraine, characterized by episodic nausea and vomiting. The treatment of CVS remains based on tricyclic antidepressants, triptans and antiepileptics. As mitochondriopathy has been involved in the pathophysiology of CVS, Coenzyme Q10 (CoQ10), a mitochondrial cofactor, has been used as the third line treatment in CVS. Considering the excellent safety profile of CoQ10, we decided to use it as the first line treatment in CVS. We retrospectively studied the evolution of 23 CVS patients who were treated for one year by CoQ10 alone. We recorded the characteristics of patients and their CVS history and compared data obtained the year before and the year following the prescription of CoQ10 treatment. We found a significant decrease in the number of vomiting episodes between the year before and the year after the start of CoQ10 (median [IQR]: 18.0 [15.75] vs. 3.00 [5.0]; p <0.001). This decrease persisted with time (2 and 3 years of treatment). The treatment was very efficient in 17/23 patients and did not decrease the number of vomiting episodes in 3 patients. Only one mild side effect related to the drug has been reported. Conclusions: CoQ10 is an efficient and safe treatment of CVS and should be used as the first line treatment in this episodic syndrome related to migraine.

Cyclic vomiting syndrome

2016 ◽  
Vol 33 (S1) ◽  
pp. S628-S628
Author(s):  
P. Cano Ruiz ◽  
S. Cañas Fraile ◽  
A. Gómez Peinado ◽  
M.D. Sánchez García
Keyword(s):  
Renal Failure ◽  
Gastrointestinal Disorder ◽  
Cyclic Vomiting Syndrome ◽  
Prodromal Phase ◽  
Frequent Episodes ◽  
Optimum Approach ◽  
Competing Interest ◽  
Discharge From Hospital ◽  
Adult Presentation ◽  
Cyclic Vomiting

IntroductionCyclic vomiting syndrome (SVC) is a functional gastrointestinal disorder characterized by paroxysmal episodes of vomiting, recurrent and cyclical presentation. Although this disorder was first described in children, recently it has increasingly been recognized in adults.ObjectiveTo know the pathogenesis of the syndrome and the optimum approach.MethodTheoretical review and cyclic vomiting syndrome brief statement of a case. This is a man of 51 years for 7 months has repeated episodes of vomiting often than 1 episode for week, with vomiting every 10–15 minutes. The patient is admitted to the neurology department for endless instability and multidirectional nystagmus and right hemispheric deficiency symptoms, with acute renal failure prerenal rehydration and study. While entering data semiotic Wernicke disease are objectified. With replacement therapy meeting evolves favorably at the time of discharge from hospital asymptomatic.DiscussionCVS, in conclusion, is a rare disease in adults whose diagnosis is one of exclusion. The adult presentation usually presents more durable, less frequent episodes. The pathogenesis remains unknown. The optimal treatment is to establish prophylactic migraine medications like amitriptyline. In the prodromal phase, it could be used ketocorolaco or sumatriptan and in the acute phase, ondansetron or lorazepam. Because of the morbidity associated with CVS, in particular the severity of symptoms, it is necessary to conduct more studies in adults.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Highly effective use of aprepitant in an adolescent girl with severe cyclic vomiting syndrome

2021 ◽  
Vol 14 (3) ◽  
pp. e241132
Author(s):  
Maria Nivatsi ◽  
Ilona Aslanidou ◽  
Elpis Mantadakis
Keyword(s):  
Adolescent Girl ◽  
Hospital Admissions ◽  
Treatment Options ◽  
Gastrointestinal Disorder ◽  
Cyclic Vomiting Syndrome ◽  
Upset Stomach ◽  
Rome Iii ◽  
Neurokinin 1 ◽  
Effective Use ◽  
Cyclic Vomiting

Cyclic vomiting syndrome (CVS) is a debilitating functional gastrointestinal disorder. Diagnosis is based on the Rome III criteria. There are no evidence-based guidelines for the management of paediatric CVS, although ondansetron and antimigraine medications are frequently tried. We describe a 13-year-old adolescent girl with severe CVS and numerous hospital admissions for dehydration because of cyclic vomiting. She had failed oral ondansetron therapy. Oral aprepitant (125 mg in the first, and 85 mg on the second and third days), a neurokinin 1 receptor antagonist that has been approved for preventing chemotherapy-induced vomiting or postoperative emesis, was tried in our patient at home during the first prodromal signs of an upset stomach. She had a dramatic response to it, with no further episodes of vomiting since its start. There is an urgent need for randomised clinical studies to assess the efficacy of available treatment options, including aprepitant in patients with severe CVS.

scholarly journals Cannabinoid hyperemesis syndrome: definition, pathophysiology, clinical spectrum, insights into acute and long-term management

2020 ◽  
Vol 68 (8) ◽  
pp. 1309-1316
Author(s):  
Mahesh Gajendran ◽  
Joshua Sifuentes ◽  
Mohammad Bashashati ◽  
Richard McCallum
Keyword(s):  
Symptom Control ◽  
Well Being ◽  
Clinical Entity ◽  
Cyclic Vomiting Syndrome ◽  
Cannabinoid Hyperemesis Syndrome ◽  
Acute Attacks ◽  
Hot Baths ◽  
Term Management ◽  
Cyclic Vomiting

Although cannabinoid hyperemesis syndrome (CHS) was first reported more than 15 years ago, it still remains an unfamiliar clinical entity among physicians worldwide. CHS is categorized by Rome IV classification as a functional gastroduodenal disorder. It is characterized by stereotypical episodic vomiting in the setting of chronic, daily cannabis use, with cycles decreasing by the cessation of cannabis. CHS is also associated with abdominal pain reduced by hot baths and showers with comparative well-being between attacks. Thus, its clinical presentation resembles ‘classic’ cyclic vomiting syndrome, but eliciting a cannabis history is crucial in diagnosing this entity. In acute attacks, parenteral benzodiazepines are very effective. For prevention and long-term management, tricyclic antidepressants such as amitriptyline are the mainstay of therapy requiring doses in the range of 50–200 mg/d to achieve symptom control. In addition, counseling to achieve marijuana cessation, accompanied by antianxiety medications, is necessary for sustaining clinical outcomes. Once the patient is in remission and off marijuana for a period of 6–12 months, then tapering the dose of amitriptyline can be implemented, with the goal of no therapy being achieved in the majority of patients over time. With the legalization of marijuana in many states, CHS will become an increasingly prevalent clinical entity, so educating about CHS is an important goal, particularly for emergency department physicians who generally first encounter these patients.

scholarly journals Non-Invasive Biomarkers for Earlier Detection of Pancreatic Cancer—A Comprehensive Review

Cancers ◽  
2021 ◽  
Vol 13 (11) ◽  
pp. 2722
Author(s):  
Greta Brezgyte ◽  
Vinay Shah ◽  
Daria Jach ◽  
Tatjana Crnogorac-Jurcevic
Keyword(s):  
Clinical Setting ◽  
Selection Index ◽  
Reporting Quality ◽  
Standard Of Care ◽  
Therapeutic Interventions ◽  
Ductal Adenocarcinoma ◽  
Index Test ◽  
Delayed Presentation ◽  
Non Invasive ◽  
Study Selection

Pancreatic ductal adenocarcinoma (PDAC) carries a deadly diagnosis, due in large part to delayed presentation when the disease is already at an advanced stage. CA19-9 is currently the most commonly utilized biomarker for PDAC; however, it lacks the necessary accuracy to detect precursor lesions or stage I PDAC. Novel biomarkers that could detect this malignancy with improved sensitivity (SN) and specificity (SP) would likely result in more curative resections and more effective therapeutic interventions, changing thus the present dismal survival figures. The aim of this study was to systematically and comprehensively review the scientific literature on non-invasive biomarkers in biofluids such as blood, urine and saliva that were attempting earlier PDAC detection. The search performed covered a period of 10 years (January 2010—August 2020). Data were extracted using keywords search in the three databases: MEDLINE, Web of Science and Embase. The Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool was applied for study selection based on establishing the risk of bias and applicability concerns in Patient Selection, Index test (biomarker assay) and Reference Standard (standard-of-care diagnostic test). Out of initially over 4000 published reports, 49 relevant studies were selected and reviewed in more detail. In addition, we discuss the present challenges and complexities in the path of translating the discovered biomarkers into the clinical setting. Our systematic review highlighted several promising biomarkers that could, either alone or in combination with CA19-9, potentially improve earlier detection of PDAC. Overall, reviewed biomarker studies should aim to improve methodological and reporting quality, and novel candidate biomarkers should be investigated further in order to demonstrate their clinical usefulness. However, challenges and complexities in the path of translating the discovered biomarkers from the research laboratory to the clinical setting remain and would have to be addressed before a more realistic breakthrough in earlier detection of PDAC is achieved.

Transthyretin Amyloid Cardiomyopathy—Current and Future Therapies

2021 ◽  
pp. 106002802110003
Author(s):  
Jankhna D. Yadav ◽  
Harjot Othee ◽  
Kelly A. Chan ◽  
Damen C. Man ◽  
Paul P. Belliveau ◽  
...  
Keyword(s):  
Cardiac Amyloidosis ◽  
Complex Disease ◽  
Clinical Presentation ◽  
Target Therapy ◽  
Data Extraction ◽  
Organ Transplant ◽  
Standard Of Care ◽  
Transthyretin Amyloidosis ◽  
Treatment Benefits ◽  
Amyloid Cardiomyopathy

Objective: To describe the clinical presentation of transthyretin amyloid cardiomyopathy (ATTR-CM) and discuss current treatments and investigational products and their effect on patient outcomes. Data Sources: A literature search was performed in PubMed (September 2018 to December 2020) using the following keywords: transthyretin amyloidosis, cardiomyopathy, polyneuropathy and transthyretin amyloid cardiomyopathy, monoclonal light-chain, tafamidis, cardiac amyloidosis, ATTR cardiomyopathy, green tea and inhibition of cardiac amyloidosis, AG10, tolcapone, tolcapone and leptomeningeal ATTR, PRX004, NI006, patisiran, inotersen, vutrisiran, AKCEA-TTR-LRx, and NTLA-2001. Study Selection and Data Extraction: Clinical trials were evaluated for evidence supporting pharmacology, safety, efficacy, and measured outcomes. Data Synthesis: Until 2019, there were no approved treatments for ATTR-CM. Treatment consisted of symptom management and organ transplant. Nonpharmacological and pharmacological treatments focused on the symptoms of heart failure (HF) associated with ATTR-CM. However, there are several emerging therapies recently approved or in development to address the underlying pathophysiology. Treatment classes for ATTR-CM include transthyretin stabilizers, human monoclonal antibodies, gene silencers, and CRISPR/Cas9 gene editing. Relevance to Patient Care and Clinical Practice: ATTR-CM is a complex disease in which amyloidosis causes cardiomyopathy. Underdiagnosis is attributed to the clinical presentation being heterogeneous, indistinguishable from HF caused by other etiologies, and the need for invasive testing modalities, including endomyocardial biopsy. Improved diagnostic approaches along with targeted therapies can slow disease progression and enhance patient quality of life. Conclusion: Diagnostic modalities along with biomarker and genetic testing could detect disease earlier and target therapy more accurately. Novel therapies demonstrate potential treatment benefits and can help shape the standard of care for these patients.

CO17 FLUNARIZINE IN THE TREATMENT OF CYCLIC VOMITING SYNDROME (CVS)

2012 ◽  
Vol 44 ◽  
pp. S248
Author(s):  
R. Mallamace ◽  
D. Comito ◽  
S. Cardile ◽  
A. Chiaro ◽  
C. Romano
Keyword(s):  
Cyclic Vomiting Syndrome ◽  
Cyclic Vomiting

scholarly journals BRAF in Melanoma: Pathogenesis, Diagnosis, Inhibition, and Resistance

2011 ◽  
Vol 2011 ◽  
pp. 1-8 ◽  
Author(s):  
Ryan J. Sullivan ◽  
Keith T. Flaherty
Keyword(s):  
Standard Of Care ◽  
Diagnostic Techniques ◽  
Therapeutic Interventions ◽  
Molecular Testing ◽  
Braf Inhibitors ◽  
Testing Methods ◽  
Braf Mutations ◽  
Initial Discovery ◽  
Braf Mutant ◽  
Mutant Braf

Since the initial discovery that a subset of patients with cutaneous melanoma harbor BRAF mutations, substantial research has been focused on determining the pathologic consequences of BRAF mutations, optimizing diagnostic techniques to identify these mutations, and developing therapeutic interventions to inhibit the function of this target in mutation-bearing tumors. Recently, advances have been made which are revolutionizing the standard of care for patients with BRAF mutant melanoma. This paper provides an overview on the pathogenic ramifications of mutant BRAF signaling, the latest molecular testing methods to detect BRAF mutations, and the most recent clinical data of BRAF pathway inhibitors in patients with melanoma and BRAF mutations. Finally, emerging mechanisms of resistance to BRAF inhibitors and ways of overcoming this resistance are discussed.

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